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Provider Update

Provider Update No. 181

Date: August 18, 2025

To: Providers

From: CalOptima Health Provider Network Management

Subject: Procedure Code Updates

Based on Medi-Cal Bulletins and Newsflashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:

  • 2025 HCPCS Quarter 3 Update
  • New PACE Managed Care Plans
  • Justice-Involved (JI) Reentry Initiative: Authorized Provider Types Updated
  • CLIA-Waived Test Reimbursement for Pharmacy Providers
  • Required ICD-10-CM Diagnosis Codes Updated for HCPCS J1756
  • Code 0345U is a New Medi-Cal Benefit
  • Modifier SL Allowable for CPT Code 90661
  • Additional CLIA-Waived Tests Procedure Codes
  • Updated Hospice Reimbursement Rates
  • CPT Code 87636 is Reimbursable as a CLIA-Waived Test
  • Frequency Update to PLA Codes 0037U, 0120U, 0239U, 0244U, 0287U and 0314U
  • Genetic Testing and Counseling Services Clarification
  • LMFT Services for IHS-MOA and Tribal FQHC Providers New Effective Date
  • New TAR and Non-Benefit List Provider Manual Sections
  • Clarification of Non-Benefit Billing Policy with an Approved Treatment Authorization Request
  • Policy Update for Echography and Radiological Ultrasound CPT Codes
  • Contracted Medi-Cal Fee-For-Service Intermittent Urinary Catheter Supplies Update
  • Provider Manual Revisions
  • TAR Criteria Update for Select DME HCPCS Code
  • The EWC DETEC User Guide has been Updated
  • Important July 31, 2025, Update: H.R. 1– Federal Payments to Prohibited Entities
  • Date Extended for the Behavioral Health Migration to the Provider Portal
  • CPT Code 90382 is Reimbursable for Billing Enflonsia

For detailed information regarding these changes, please refer to:

To access the updated Physician Administered Drug Prior Authorization List (PAD PA List), please refer to
https://www.caloptima.org/en/ForProviders/ClaimsandEligibility/PriorAuthorizations.aspx.

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